Effect of haemodilution by intravenous crystalloids on coagulation system in surgical breast cancer patients

ABSTRACT

Aside from the efficacy of a specific solution, possible side-effects have become an increasing concern. One of the most important issues for assessing the optimal intravascular volume replacement strategy is the influence on the haemostatic process and subsequent influence on bleeding or the development of thrombosis. The aim of our study is an assessment of the effects of intravenous fluid administration especially crystalloids during operation in a progressive manners [progressive haemodilution] on coagulation system in cancer patients [breast cancer]. 36 female patients scheduled for breast cancer surgery above 18 years, weight ranged from 50-70 kg, ASA physical state I or II were included in the study and exclude all anaemic patients, patients with abnormal preoperative coagulation data. Patients were divided into 3 groups according to degree of haemodilution depending upon their haemodynamic stability Group A [12 patients] volume infused to them up to 500 ml saline 0.9%, Group B[12 patients] received 1000 ml and Group C[12 patients] received 1500 ml. All patients received general anaesthesia and continuously monitored with ECG, central venous pressure [CVP], non invasive blood pressure and pulse oximetry in each group during the period of surgery and the first 24hours postoperatively. Blood samples taken before surgery, after induction of anaesthesia, after the end of fluid infusion, after surgery, 5 hours, 12 hours and 24 hours postoperatively and the following parameter was measured complete blood picture, prothrombin time, prothrombin concentration, International normalized ratio [INK], activated partial thrompolastin time [a PTT], fibrinogen, fibrin degradation product [FDP], factor VIII, antithrombin III [AT III] and thrombin antithrombin complex [TAT]. The present study demonstrate no significant difference in white blood cell count, haematocrite value or platelet count apart from slight reduction in platelet count in between group A and B, while there is a steady decrease in red blood cell count [RBCs] and haemoglobin concentration [Hb] in the same group and in between the three groups. There was significant increase in prothrombin time, activated partial thromboplastin time and international normalized ratio [INR] in group A, while in groups E and C shows increase in prothrombin time and INK Prothrombin concentration was significantly decreased in the three groups. Fibrinogen concentration was significantly deceased in the same group and in between groups. Factor VIII concentration shows no significant difference in the same group and in between groups. Also, in AT III concentration shows slight reduction in it but no significant difference in the same group and in between groups. Fibrin degradation product [FDP] show no significant difference in the same group and in between groups, while the concentration of thrombin antithrombin complex [TAT] in our study shows significant increase in group A and C but in between groups there were no significant changes. The relationship between haemodilution thrombosis and haemostasis is probably more complicated than we used to believe. We found limited crystalloids administration with slow rate of infusion during surgery is beneficial for patient postoperative coagulation. Intravenous fluid administration, while being routine therapy for patients in operating rooms, may be harmful used in rapid fluid loading